clifford



July 20, 1937. P. J. CLIFFORD 2,087,838 A APPARATUS FOR DIAGNOSING AND TREATING DBAFNESS Filed Jan. 20, 1932 5 Sheets-Sheet 1 70 L INE July 20, 1937. P. J. CLIFFORD APPARATUS FOR DIAGNOSING AND TREATING DEAFNESS Filed Jan. 20, 1932 5 Sheets-Sheet 2 Inventor.

T M W .J 7. m 2 2 2 1 4 m 2 a, m w M 1; a 1 7 w 0 1 9 2 July 20, 1937. P, ,1 RD 2,087,838

APPARATUS FOR DIAGNOSING AND TREATING DEAFNESS Filed Jan. 20, 1952 5 Sheets-Sheet 3 TO LINE Inventor:

July 20, 1937. P. J. CLIFFORD APPARATUS FOR DIAGNOSING AND TREATING DEAFNESS Filed Jan. 20, 1932 5 Sheets-Sheet 4 ks n 99 Inventor.- 2 6 July 20, 1937. P. J. CLIFFORD APPARATUS FORDIAGNOSING AND TREATING DEAFNESS 5 Sheets-Sheet 5 Filed Jan 20, 1932 u mmw m SS U $N .LN Ev Patented July 20, 1937 UNITED STATES PATENT OFFICE APPARATUS FOR DIAGNOSING AND TREAT- ING DEAFNESS Application January 20, 1932, Serial No. 587,826

26 Claims.

My invention relates to that class of instruments used by otologists in testing, diagnosing and treating defects in the organs ofhearing.

The object of the invention is to provide a machine so constructed as to be capable of producing, singly or in combination, by means contained therein, functional tests of the ear to determine a degree of deafness, the reason therefor, and the treatment thereof, while the part being tested or treated and the effect produced thereon is autoptically visible to the operator, together with synchronizing means to produce a printed chart of the complete examination or, in so far as the ear is concerned, a health audit.

Other and further important objects of the invention will be apparent from the disclosures in the accompanying drawings and the following specification.

' In the drawings, forming a part of this specification, like characters of reference refer to similar parts throughout the several figures, in which:

Figure 1 is a front elevation of the complete apparatus including the flexible tubing for the use of the patient and operator.

Fig. 2 is an end elevation, viewed from the left of the machine.

Fig. 3 is a similar view from the right end.

Fig. 4 is a top plan view.

Fig. 5 is a vertical transverse sectional view.

taken on line 5-5 of Fig. 1.

Fig. 6 is an enlarged vertical transverse section on line 66 of Fig. 1.

Fig. 6a is a detail plan view of locking plate shown in Fig. 6.

Fig. 7 is an enlarged fragmentary section on line 'I'I of Fig. 1.

Fig. 8 is a fragmentary face view of the printing dial carriage with the dial showing in dot and dash lines for clearness.

Fig. 9 is a vertical longitudinal section through the fan mechanism.

Fig. 10 is an enlarged central vertical section through the vibratory indicator.

Fig. 11 is an enlarged fragmentary sectional view of the motor speed control.

Fig. 12 is an enlarged sectional view of the visascope on line I2--I2 of Fig. 1.

Fig. 13 is a fragmentary horizontal sectional plan view of the automatic chart moving mechanism.

Fig. 14 is an enlarged detail-view of the sound record alignment mechanism.

In the drawings I indicates a silent motor having a speed of 8000 R. P. M., or more, provided with an elongated shaft 2, journaled at one end in a vertical standard 3. Actuating means are disposed on this shaft for setting in motion the various parts of the machine.

A case 4 is provided in which part of the apparatus is housed, said case having a hinged cover 5, upon which the motor assembly is mounted. There is also provided an air and sound casing 6, (see Fig. 5) of cylindrical form, and being flanged centrally thereof for mounting into the cover 5. The casing 6 is divided internally into two uneven chambers 11 and 8, the dividing wall 9 having a central opening III], in which is mounted sound insulating means, comprising a valve II. The casing B is closed at its top by the screw cap i2.

Mounted in the chamber 1 is a heavy, resilient diaphragm I3, which is seated on the annular shoulder of the chamber, and rigidly held in place by the screw threaded flange of the cap I2. A vibrating member I4 is fixed in the center of diaphragm I3, the stem of which extends upward, and is guided in its movement by a central opening in cap I2. Motion is imparted to the vibrating member I4 by means of a plate cam I5, the edge of which is shaped to give the required reciprocating motion. A leaf spring I5 is interposed between the cam I5 and the member I4, and in constant engagement with both, to provide a wiping, noiseless contact, to depress member I4. The cam I5 is enclosed in a suitable housing I5", which is attached to the screw cap I2. The actuation of cam I5 will cause the member I 4 to vibrate the diaphragm l3 four times for each complete revolution of the motor shaft 2, by reason of the four elevations on the face of the cam. Thus, there will be produced in chamber I, air pulsations of a predetermined value, depending on the speed of the motor, the control of which will be described hereinafter, said pulsations being discharged through the outlet tube I6, and diverted by one of its bifurcated ends to flexible tube I6a, through a visascope I6b to the ear of the patient (Fig. 1).

The visascope IBb (Fig. 12) is provided with focusing means consisting of a suitable lens I60, and an inclined mirror I 6d of the magnifying type, which is adapted to be adjusted by a thumb screw I6e to bring an enlarged and clarified view of the part being tested or treated upon a ground glass plate l6).

An auricle tube I69, is provided with transverse tubular passages I6h, adapted to receive the bifurcated ends of the flexible tube l6a. The lens lie is mounted in the large part of the auricle tube I 6a, in the rear of air passages I6h, and the usual light bulb |6i is provided for proper interior illumination. A flexible tube I67 (Fig. 1) is provided in order that the operator may check the functions of the machine when testing.

Means are provided for removing the vibrating member M from operative contact with the cam (see Figs. 2 and 5). This means comprises a lever |1, pivoted at one end in lugs |2 near the outer edge of screw cap I 2, and extending transversely across the top thereof, and through the slot |4' of the vibrating member |4, terminating in a button l8. Detent means I9 is provided to hold the said lever in depressed position.

The bottom chamber 8 (Fig. 5) is constructed along the lines of the well-known phonograph reproducer, the purpose of which is to convey sound into chamber 1 for discharge therefrom. Chamber 8 contains a diaphragm 20, held in place by a bottom screw cap 2| of easing 6.

Attached to the center of the diaphragm 20 by suitable means is a tone arm 22, which extends down through the center opening of screw cap 2|, being fulcrumed in lugs at 23 and adapted to hold the stylus 24 at its outer end. The tone arm is capable of being raised or lowered, in or out of operable contact by means to be hereinafter described.

Sound mechanism is provided, consisting of a suitable record 21 of cylindrical shape, upon which may be recorded any number of desired sounds for the purpose herein specified.

Each sound is a separate and distinct recording, forming a continuous groove on the periphery of the record, and being equally spaced, to assure synchronic relation with a movement of the record and a setting of a dial 43 for tone selection, the method of which will be hereinafter described. Mounted on shaft 2 of motor is provided a small friction gear 28, (see Figs. 1 and.3) which drives a large, intermediate friction gear 29, which in turn, drives 'a friction gear 33 comprising a. gear-train to drive the sound mechanism. Gear 29 is journaled on a. stud shaft 38, and carried in a movable bearing 3| mounted in the cover 5, and adapted to be moved in or out of operable contact with the gears 28 and 38, through the action of a. push-pull bar 32, and held in either position by detent means 32'.

Gear 33 is fixed on a shaft 34 which is supported by adjustable pivot bearings 35' in a yoke shaped frame 35. This yoke shaped frame is mounted on a hinged door 36, which is part of the bottom of case- 4, being so constructed as to permit easy access to the sound mechanism.

Slidably mounted on shaft 34 (Fig. 5) is a cylinder 31, adapted to carry the sound record 21. The shaft 34 is squared for about two-thirds of its length, and the bearing of the cylinder 31 is correspondingly squared to assure positive rotation. Cylinder 31 is normally pressed leftward (Fig. 1) by a conical coiled spring 38 against a sleeve 39, which is slidably mounted on the round part of shaft 34.

The sleeve 39 (Figs. 6 and 14) has on its upper surface a rack 39', adapted to mesh with a gear 40 which is fixed on a hollow shaft 4|, the outer end of which is flanged, and adapted to have attached thereto, a dial 43. Shaft 4| rotates in a bearing 42. attached to, and supported in the front wall of case 4. Set screw 44 is provided to engage with an annular groove 45 in the shaft 4|, allowing rotation, but preventing longitudinal movement thereof, and to hold the dial 43 flush with the wall of case 4.

The dial 43 has on its face a series of characters, accurately calibrated, which, when aligned with an arrow 43' on the wall of case 4, will designate the sound selected, and indicate that a sound groove in record 21 is properly aligned to receive the needle 24, and bring the chart 16 to its proper position under the printing dial to receive a character by means hereinafter to be described.

A knurled knob 46, is suitably attached to the outer end of a solid shaft 26", holding a metal disc 41 rigidly fixed against the shoulder of the shaft. This shaft has for its bearing the hollow shaft 4|, and has limited rotatable and longitudinal movement therein. On its inner end, and being an integral part thereof, is a barrel cam 26, having a groove 26 milled in the body of the cam to the extent of one-half of its circumference, or an arc of 180 degrees, as shown in Fig. 6.

The groove 26' is engaged by a lever 25, hinged and guided in lugs 25, the engagement being assured by a leaf spring 25". The angle of the groove in the cam is designed to move the shaft 26" longitudinally in either direction, simultaneously with the lifting of the lever 25, when the cam is rotated. The front wall of case 4 is recessed to a depth that will permit a washer 48 to be forced over bearing 42 until it is flush with the face of case 4. Washer 48 has a plurality of holes 48 (Fig. 6a) in it, equal to the number of sound calibrations on the face of the dial 43, and so designed, that the top hole in the washer 48, a character on dial 43 and the arrow 43' will be in exact alignment, when a sound groove has been selected. Dial 43 has a hole in it directly beneath the characters C 255, the bottom of which is the flanged end of the hollow shaft 4|. The purpose of this hole is to contain a locking tumbler 49, which has two diameters, the smaller adapted to fit a hole in the flange 4|, and any hole in the washer 48, (Fig. 6) and is spring pressed outwardly'against the disc 41, v

by a coil spring 50. The purpose of the mechanism just described is three-fold:

1. To raise the needle and unlock dial 43.

2. To lower the needle and lock dial 43.

3. To prevent longitudinal movement of the record 21 while the needle is in a sound groove, thus positively preventing injury thereto.

The sequency of these operations is as follows: When knob 46 is turned clock-wise to its full limit, cam 26 will raise lever 25 which lifts tone arm 22, and raises the needle out of contact with record 21; simultaneously therewith, the action of lever 25 in cam groove 26' through shaft 26" forces disc 41 outward when tumbler 49, by the action of its spring 50, is forced out of engagement with a hole 48' in washer 48, completing the unlocking movement. ,Dlal 43 is now free to be rotated in either direction to select another tone groove, bringing tumbler 49 directly over another hole in the washer 48.

When the selection is completed, knob 48 is turned counter-clockwise to its full limit, causing shaft 26" to move inward, when disc 41 will force tumbler 49 into a hole in the washer 48, locking dial 43, and allowing lever 25 to lower tone arm 22, and the needle 24 will be in a tone groove in record 21 ready for test.

The intensity of the tones produced is controlled by the valve I through a knob mounted on a shaft Ila. Dial means ||b (Fi 1) is calibrated to indicate distance in feet in order that the operator may determine the, exact distance a sound is audible to the ear of a patient,

I i. e., when the valve II is open to its full extent,

the indication on the dial lb shows no distance, and the maximum volume of tone is delivered to the ears of the patient. As the valve is closed, the distance on the dial is increased, to the point where the sound is no longer audible, so that when the maximum distance is indicated the valve is positively closed, and all sound is beyond the range of the patients hearing.

Thenumber of pulsations produced in the chamber 1 may be varied as required, by the use 'of a control mechanism consisting of a disc 5| (Fig. 1) slidably mounted and feathered on shaft 2, and pressed outwardly by spring 52, which is seated against a fixed collar 5| on the shaft. Mounted in the upright standard 3 is a threaded stem 53 (Fig. 11) having on one end, a cup,

speed of the shaft 2 by frictional contact with disc 5|. Means for indicating the number of pulsations per second, associated with the control disc 5|, and consisting of an arm 55, mounted on the rear end of shaft 56, as shown in Fig. 10, to-

which is fixed a segmental gear 51, that meshes with, and rotates a pinion gear 58, against the tension of a hair spring 58', the purpose of which is to return a hand 59 to its normal position on a dial 60, (Fig. 1) which is suitably held within the case 66'.

As heretofore stated, if the speed ofshaft 2 is 8000 R. P. M., and the speed is decreased by the pressure of pad 54 against the disc 5| until the R. P. M. of the shaft is 3840, it is obvious that the cam I5 will depress the member |4, four times for every revolution of the shaft, or 15,360 times per minute, which will be 256 times per second, or the same number of vibrations produced by the tone of middle C of the musical scale. When the dial 60 is set to indicate 256, and the dial 43 shows a like indication, the air pulsations and tonal vibrations will be delivered in perfect synchronism.

A current of pressure air, as distinguished from air pulsations, is delivered to chamber 1 of casing 6 by means of the fan mechanism shown in Fig. 9. A fan 6| (Fig. 3) contained in a housing 62 is mounted on the rear end of motor housing and adapted to be actuated by a clutch 63 fixed on the motor shaft 2. Means is provided to put the fan in or out of operable contact with the clutch 63 by a lever 64. Shaft 2 is hollowed to receive a spring 65, (Fig. 9), which exerts sufficient pressure against fan hub 66, to keep it out of contact with cone 63, and to secure a ballbearing 61 in place between the said hub and a bearing block 68, which rests against a cam 69, being normal position as shown. The raising of lever 64 to a vertical position as shown in Fig. 3, will cause the fan assembly to move into operable contact with clutch 63. Air is then forced by Way of a passage 10 (Fig. 4) into an elongated tube adapted to receive at one end thereof, a heating element 72, thermostatically controlled by button H, and having in its circuit a light 12' to indicate the on or off condition of the element. At the other end of tube H is an outlet I3 connected with chamber 1 of casing 6 for the passage of air thereto. The passage 13 is provided with a check valve 14 of the ball type, making it unidirectional. The cap 15 of the tube H, is held in place by a bayonet slot, and is for the purpose of inspecting the interior of tube ll.

Charting means, forming a part of the apparatus, is provided, and is adapted to record upon a suitable card or form, the final results or tests produced by the device. In the front wall of the case 4 as clearly shown in Figure l, is an elongated window 4' through which the face of the chart or record-form I6 is accessible for recording thereon. This chart is of slightly greater width than the window but only half as long, and is adapted to be carried in a metal plate 11, having its upper and lower edges turned to hold the card in place; case 4 is suitably recessed and slotted a sufficient distance along its front wall to receive and guide the metal plate 11. Thumb notch 18' is provided to facilitate the removal of the card 16.

Parallel guide rails 19 and 80 are arranged horizontally in corresponding recesses in the front wall of case 4 above and below the chart window.

-'The metal chart carrying plate 11 is adapted to be guided by the rails 19 and 80. A carrier bar 8| (Fig. 13) is attached to the front wall of case 4 at a point intermediate of the chart window 4', and is adapted to carry a rotary printing dial 62, which is vertically adjustable in slot 8|b of the carrier bar 8| and is designed to contain a series of depressible keys 83 normally spring retracted, and provided with printing characters 84 on their bottom faces, corresponding with the characters shown on the keys 83, the star indicating normal, the plus sign, abnormal, the minus sign, subnormal, the zero, nil.

Reverting to the dial 82 on the carrier bar 8|, details of which are shown in Figures '7 and 8, it will be seen that the stem 82a is flattened to pass freely in the slot Na, and is provided with an enlarged head 82b, engaging the under side of the slot to hold the disc firmly against the carrier bar. Around the flattened portion of the stem 82a is fixed a detent spring 820, adapted to engage notches 8 c spaced to correspond with spaces on the chart. A small inking roller 84a is provided under the dial 82 in the path of the printing characters 84 as they are brought to the printing point.

The chart 16 is adapted to have the results of tests symbolically printed in the proper spaces, and is so designed as to receive a. number of complete recordings printed thereon, each in its designated space, in accordance with the printed characters on the chart. Each space on the chart will be automatically moved to align with a selected character of the printing dial 82, and in synchronism with the corresponding movement of dial 43. This is accomplished by means of a bevel (Fig. 13) gear 85 fixed on the hollow shaft 4| and meshing with a small bevel gear 86 fixed on the end of a horizontal shaft 81, mounted in an elongated bearing 38, which is fastened to the rear of the front wall of case 4 and held against longitudinal movement by the collars 81' pinned thereon. Beyond bearing 88 the shaft 5'! is threaded for the remainder of its length, to receive and move a nut 89 which is adapted to be fastened to the back of the metal plate 11 by suitable means for imparting movement thereto. The nut 89 is limited in its movement in one direction by the collar 81' and in the other direction by the fixed collar 81".

The gear 46 which actuates the rack 39' previously described, is provided with a pin 40a (see Fig. 14) which is adapted to pass over the upper- Bill the gear 40 when it has been moved rightward'to its full limit. The sleeve 39 is champered at its lower edge, and the spring BI is correspondingly shaped as shown at St. When the tooth 40b of gear Ml forces the last tooth of rack 39 clear of the gear 40, against the pressure of spring 38 (Figs. 1 and 14) the champered end oi spring 9!, as shown at M, will force itself upward against the champered edge of the sleeve 3Q, thus allowing tree rotation of gear it for the selection oi tests other than tonal tests, namely, caloric, right, left, both, and home condom tiori tests. When the dial d3 is turned to its lull limit, the character will he in line with the arrow ahove it (see Fig. i) the space the will he directly under the uppermost character on the printing dial till, thus coma hear ng test. To return the sound tus to normal position asshowh Flgm the dial it tumed clockwise cam the pin the. to pass over the vertical bar for 'l'lE downward to disengage the edge Oi racl: 3Q, bringing "he rack hee moi position ready for another test.

dial E2 is then moved one deteht to begin Principles underlying" tests of hearing it. normal range of hearing is from. diltllt doulole vibrations per second.

it. llllheu the conduction apparatus or ohstmcted, the hearing for the low of the scale is impaired or lost.

When the perception apparatus is diseased, the hearing tor the high tones is lost.

The normal ear hears about twice long oy air conduction as by hone conduction. That is, a sound heard by home for til seconds will he heard about cc seconds when held close to ouricle.

5.. When the conduction apparatus diseased or obstructed, hone conduction is increased and the time left in which the sound should he heard by conduction is diminished; or bone conduction may he so much increased that the sound is heard longer than by air conduction.

6. When the perception apparatus is diseased bone conduction is diminished or shortened, and the relative time of hearing by air conduction is exaggerated.

The functional tests of the auditory apparatus and their purpose is well known to those skilled in otology, so, I will confine myself to describing how the apparatus makes these tests.

Technique.--The patient being seated, places the auricle tube l6g in the ear, then an enlarged view of the eardrum will show on the ground glass plate l6 of the visascope exposing its conditlon. After adjusting the tube l67 to his ears, the operator causes the machine to operate by pushing button M. It is obvious that he may now produce any of the functional tests of the ear by proper manipulation of the controls and note the effect by means of the visascope, but for the sake of clarity, I will describe a full test of the machine, to determine the acuity of hearing, the degree thereof, and the method of treatment. The machine as shown in Fig. 1 is ready for test, or in normal condition. The adjustable member I8 is depressed, preventing actuation of the diaphragm rod M (Fig; 4). Fan control lever 64 has the fan out of actuating contact (Figs. 9 and 1). Control 32 is in position to cause the gear train (Figs. 1 and 3) to operate the sound mechanism as shown in Fig. 1. It will be noted that the dial 43 is set at C'--256, and valve I! (Fig. is opened to half of its full extent. The eardrum is now receiving tonal vihrations at the rate of 256 per second, of normal intensity, produced by the musical note middle (3, and the space on the chart directly under the character 0 is in proper alignment to receive the impression of any of the printing characters 83 of the dial 82, to designate the degree of audiloility. Ii the patient does not hear the tone, the sound mechanism is up by manipulating thumb lit", thus intensifythe tone until he. Vl hen thumb y of the re tone intensity to its d to its record ti has increased maximum pc hen v full extent. l

loss of tone, wi

cc npletely hear- The patient is te tones as indicated on. t and the degree, normal, t

obvious the audihility o:

wh her it heard ohove below normal, or

heard at all.

To produce hystagmus, the lever 54 is put. into actuating position, when t ot a less temperature than the body will he forced against the eardrum, and functional tests or the vestibular apparatus may be produced.

A. thorough knowledge of the vestibular reactions to certain stimuli under both normal and pathological conditions is absolutely essential to the differential diagnosis of several labyrinthine and intracranlal pathological processes. Under certain conditions the use of water, hot or cold, is positively contraindicated, irrigation is dangerous when a fistula through. the lateral labyrinth wall exists, pus may he carried to new points, easily converting a circumscribed into a diffuse labyrlnthitis.

Two tests, each attended with difierent reactions are produced by the machine:

Heat test-The fan Si is put into operation by lifting lever 64. After heat element 12, (Fig. 4) in tube H is heated by heat control button H, warm air will flow to the ears of the patient as heretofore described. As the endolymph in the utriculus is warmed, it rises through the anterior vertical semi-circular canal, and thus stimulates the crista ampullarls of this canal upon the plus side of greatest physiological activity. The result is, therefore, limited to rotary nystagmus to the right.

C'old test-The heat is cut off, and air less than body temperature flows into the ear. As the endolymph in the anterior vertical and horizontal canals and the utriculus is cooled, it seeks the lowest level, hence the movement of the endolymph in the anterior vertical canal is from the ampulla to the utriculus. The crista ampullaris is thus stimulated upon the side of least physiological activity and causes rotary nystagmus to the left. The endolymph also flows downward from the utriculus through the ampulla of the horizontal canal, and stimulates the cristi ampullaris upon its side of least physiological irritability and produces horizontal nystagmus to the left. The total result of the cold air application is, therefore, a combined horizontal and rotary nystagmus to the left, or opposite side. It will be clearly noted that if the eardrum is perforated, air (hot or cold), will penetrate into the tiniest interior cavity without danger of carrying pus thereto. If the production of nystagmus ls stubborn in either event, detent lever I8 is released and vibrations of any desired amount set up, and favorable results are produced by the added vibratory stimulation.

A bone conduction test is performed as follows: Place the aurial tube I69 on the median line of the skull and have the external meatus of one ear closed, and all parts of the machine out of operation except the sound mechanism. If the sound lateralizes to the left ear, the soundconduction apparatus of that ear is diseased. If the sound lateralizes to the right ear the perception apparatus is afiected.

If the patient fails to respond to tonal sounds the detent I8 is released and with the vibrations synchronized with the tone, the result will be amazing. The combination of both will cause the most stubborn case to respond at once.

The same is true if the ear fails to respond to tones, the synchronic tones and vibrations combined will overcome a stiffened tympani and the result is instantaneous.

Pneumomassage is given with the combined heat and vibratory elements of the machine operating, and the degree of massage controlled by the manipulation of thumb screw 53'.

Tympanic inflation is produced by inserting the aurlal tube lBg into the nose, with the fan, vibratory and heat element in operation differing from the usual method, as heat adds to stimulation, vibration breaks down the hardened muscosa and allows the air to flow to the inner ear resulting in the effects previously described in this specification. During this process the ridge forming the posterior lip of the mouth of the Eustachian is visible to the operator, its patency and the effects of the treatment clearly'observed.

It will be understood that the apparatus above described is illustrative of my invention and is not to be considered in a restrictive sense, and changes can be made without departing from the principles involved.

I claim:.

1. In an apparatus for testing and diagnosing defects of the organs of hearing, so constructed as to be capable of producing singly or in combination, by means contained therein, functional tests of the ear to determine the degree of deafness, and the reason therefor; comprising driving means, air pulsating means actuated by said driving means, dial means to indicate the number of air pulsations produced by said driving means; means actuated by said driving means to produce specific tones, adjusting means associated therewith adapted to synchronize the said tones and air pulsations with means to indicate the vibrational number of the said tones; valve means to control the volume thereof; means-to produce a current of air pressure, with means to heat the said air to required temperatures; a chamber to receive the products of the apparatus, being integral therewith; control means to cause said tones and the air current of pre-determined temperature and the air pulsations, to be produced singly or in combination within the said chamber; tubular devices associated with said chamber to convey the said products to the ear of the patient; and charting means, forming a component part of the apparatus, for recording the result of a test for diagnostical purposes.

2. In an apparatus of the class described the combination of a motor, means associated with said motor for producing air pulsations of varying rapidity, an indicator to show the number of pulsations being produced, means for producing sound having known characteristics, adjusting means for synchronizing the said pulsations and sound, and means for conveying the synchronized pulsations and sound to the same part to subject the same simultaneously to the conjoint action of said pulsations and sound, substantially as described.

3. In an apparatus of the class described the combination of a motor, means associated with said motor for producing air pulsations, adjusting means for varying the rapidity of said air pulsations, an indicator to show the number of pulsations produced, means for producing sounds having different rates of vibrations, means for synchronizing the said pulsations and sounds with means for discontinuing the pulsations or the sounds and for varying the intensity of the sound.

4. In an apparatus of the class described the combination of a motor, means associated therewith for producing air pulsations, adjusting means for varying the rapidity of said air pulsations, means for producing sounds having difierent rates of vibrations, means for conveying said pulsations and sounds jointly to the ears of a patient, means for synchronizing said pulsations and sounds, with means for supplying through said conveying means air at difierent temperatures to the ears of the patient in combination with the said pulsations and/or sounds.

5. In an apparatus of the class described the combination of a motor and vibrating means connected thereto, controlling means therefor, including braking means to reduce the speed of the motor, means actuated by the said controlling means to indicate the number of vibrations produced per second, means to eliminate the vibratory means without interfering with the braking means and means operated by the motor and generating a force, to be applied to the ear, other than that derived from the vibrating means.

6. In an apparatus of the class described including sound reproducing means having capacity to reproduce any one of a number of different tones, actuating means therefor, means for selecting any one of said tones, dial means to indicate the character of the sound produced and means associated therewith to control the intensity of the sound of the tone selected, said sound reproducing means comprising a plurality of sound reproducing elements each of which is individual to only one of the series of tones to be selected, said one tone being individual to one of said elements.

7. In a device for diagnosing and testing deafness, comprising means for producing different forces, means for setting the device for producing one of the different forces, means for conveying said forces to the ear of a patient, means for permanently recording the effects of said forces on the patients ear, comprising a card and a holder therefor moving under a printing station, characters on the card representing various tests, with means for bringing that portion of the card under the printing station which has a character corresponding to a given force produced by the machine, said last mentioned means being con.- nected to and actuated as a consequence of operating the setting means.

8. In a device for diagnosing and testing deatness, comprising means for producing different forces, means for setting the device for producing one of the different ior'ces, means for conveying said forces to the ear of a patient, means for per manently recording the eifects oi said forces on the patients ear, comprising a card and a therefor moving under a printing station, char actors on the c d representing various with means for rising that portion of the card under the printing station which has character corresponding to a given force produced by ti machine, said iast mentioned means being co; nected to actuated a consequence oi crating the setting means, with means for p ing on the card the effects of the forces patients ear.

9. in a device for diagnosing deainess, prising means for ducing dii'ierent somids by a phonograph record which has adjustment re tive to a phonograph. needle to produce ti 1. torrent sounds, means to convey said sounds a patients ear, means for permanently ording the effects of said sound conveyed to the w ear, said recording means including a holder therefor which moves under station, means for eiiecting the adjustment oi the phonograph record and the simultaneous ad justment or the paper holder, with loclrhig means to prevent movement or holder and paper held thereby, and also the adjustment of the phonograph record the phonograph needle is moved out of: contact said phonograph record.

10. Apparatus according to ciaiin'i in which means are provided for segregating the produo= tion or the air pidsations, the production oi the sounds, and the production of the air pressure.

11. Apparatus according to claim 1 in which charting means are adjustable automatically through connections leading from the indicating means for the sound producing means.

12. In combination in apparatus of the class described, an auricle tube, means for producing pulsations of air through said tube, means for producing tone vibrations in said tube simultaneously with the existence therein of the air pulsations, and means for varying the rate of air pulsations in said tube to synchronize with the tone vibrations in said tube, substantially as described.

13. Apparatus according to claim 12 in which the rates of tone vibrations may be varied, substantially as described.

14. Apparatus according to claim 12 in which a, pressure current of air as distinguished from air pulsations is delivered to said tube simultaneously with the existence in said tube of air pulsations and tone vibrations.

15. Apparatus according to claim 12 in which a pressure current of heated air is delivered to said tube simultaneously with the existence therein of air pulsations and tone vibrations.

16. Apparatus according to claim 12 in which means are provided for varying the strength of the tones existing in the tube to determine the distance at which the tones can be heard.

1'7. Apparatus according to claim 12 in which means are provided for varying the strength of the tones to determine the distance at which the tones can be heard, and means for indicating said distance.

18. In apparatus of the class described, an auricle tube, means for producing continuously any one of a plurality of tones in said tube, a valve for regulating the strength of any selected tone delivered to said tube to determine the distance of hearing, means for moving the valve to i incr see, or decrease, the size of the opening through which the sound is delivered to said. tube, a d an indicator connected with the valve open 5 mg mechanism to show the setting of said valve to indie te la. in

e class described,

selecting c amber, a r. cans for time it char. r for producin o iisations, a motor, contween 'or the air pulsatie samaa brake for vary-- the transmissio power to said air pulsating producin leans, and an indicator for indicating the rate of podsations, said indicator being variably controlled by the hraking means acoordins; to the degree oi. the braking eflfect.

22. In apparatus of the class described, means for producing" air pulsations, means for producing tones, means for synchronizing the rate of air pulsations with the rate of vibrations of the tones, and means for delivering to the ear the synchronized air puisations and tone vibrations, substantially as described.

23. In an apparatus for testing and diagnosing defects of the organs of hearing, so constructed as to be capable of producing singly or in combination, by means contained therein, iunctional tests of the ear to determine the degree of deafness, and the reason therefor; commeans i. nections prising driving means, air pulsating means actumeans to produce a current of air pressure, with means to heat the said air to required temperatures; a chamber to receive the products of the apparatus, being integral therewith; control e ees ese means to cause said tones and the air eument m? predetermined temperature and the air p tions, to be produced singly m" in eombinetiien within the said chamber; tubular devices assseieted with said chamber to ccnvey the said prefl= ucts t0 the ear of the patient; and means for viewing the parts being tested t0 ebserve the effect of said tones and the current 01 psedeter mined temperature and the air puisatiens thereon.

24. Apparatus according to claim 23 in which means are provided for segregating the pzefiuw ticm of the air pxflsations, the produetien of tones, and the production of the air pressure.

25. The combination of a tuhuiar eieviee mash ed to convey sound and/or air pulsations to the ear, an auricle tube to enter the ear and commiinicetine with said tubmsr device, and for viewing pasts e1" the em subjected he seid pnisetions cmnhinetien mi 1% tub-nine devise adepted to ecnveysnund end/e1 m pulsations t0 the ear an enrieie "tn-enter the em and eemmnnieeting with said tubules de -flee, and means for viewing parts 0f the ear subjected tn send pulsations, said means comprising a visaseepe prsvided with a lens, an inclined miner of magnitying type associated therewith, adjusting means fez a light in preximity te said minor, and a ground glass plate operative-3y related, to said mirror to receive the magnified and View.

PATRICK J. CWFORD. 

